Clinical practice guideline presents multidisciplinary approach to diabetes foot care
The guideline addresses prevention of diabetic foot ulceration, off-loading of diabetic foot ulcers, diagnosis of osteomyelitis, wound care, and peripheral arterial disease.
Three medical societies collaborated to issue diabetic foot care guidelines that address 5 areas of care.
The Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine developed the clinical practice guideline based on 5 systematic reviews of the literature. The 5 areas of focus are prevention of diabetic foot ulceration, off-loading of diabetic foot ulcers, diagnosis of osteomyelitis, wound care, and peripheral arterial disease.
To prevent diabetic foot ulceration, the guideline said that patients with diabetes should undergo annual interval foot inspections by physicians or advanced practice providers with training in foot care (Grade 1C), including testing for peripheral neuropathy using the Semmes-Weinstein test (Grade 1B). Patients and their families should be educated about preventive foot care (Grade 1C). Routine use of specialized therapeutic footwear in average-risk diabetic patients is not recommended (Grade 2C), but custom therapeutic footwear is recommended for high-risk patients, including those with significant neuropathy, foot deformities, or previous amputation (Grade 1B). Adequate glycemic control (HbA1c <7% with strategies to minimize hypoglycemia) is recommended to reduce the incidence of diabetic foot ulcers and infections, with subsequent risk of amputation (Grade 2B), but prophylactic arterial revascularization is not (Grade 1C).
Recommendations in the other areas of focus include off-loading with a total contact cast or irremovable fixed ankle walking boot for patients with plantar diabetic foot ulcers. In patients with a new diabetic foot ulcer, the guidelines recommend probe to bone test and plain films to be followed by magnetic resonance imaging if a soft tissue abscess or osteomyelitis is suspected. After comprehensive wound care and various debridement methods (according to specifics described in the guideline), diabetic foot ulcers that fail to improve (>50% wound area reduction) after a minimum of 4 weeks of standard wound therapy should be treated with adjunctive wound therapy options. Revascularization by either surgical bypass or endovascular therapy is recommended for patients with diabetic foot ulcers who have peripheral arterial disease.
The guideline was based on best available evidence and consideration of patients' values and preferences and will be updated as new evidence becomes available, the authors said. It appeared in the February Journal of Vascular Surgery.